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Medicare vs. Medicaid
Medicare is a federal health insurance program that brings coverage to America’s seniors and those with disabilities. Medicaid is a program jointly funded by state and federal governments, and it covers people with low incomes and limited resources.
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Eligibility For Medicare vs. Medicaid
To be eligible for Medicare, you must be a U.S. citizen or legal permanent resident of at least five years and be age 65 or older, have been receiving disability benefits from Social Security or the Railroad Retirement Board for at least 24 months, have amyotrophic lateral sclerosis (ALS), or have End Stage Renal Disease (ESRD) and be in your fourth month of treatment.
To be eligible for Medicaid, you must have limited income and resources. There is no age requirement for Medicaid, and there are specific benefits to provide enhanced insurance for children. Requirements for the various programs under Medicaid may differ in your state, and not all states offer the same programs.
Medicare vs. Medicaid Coverage
Medicare coverage consists of Medicare Part A and Part B. Part A is inpatient insurance for care in a hospital or skilled nursing facility, certain nursing home care, hospice care, and home health care. Part B is outpatient medical insurance covering medically necessary and preventative care. Part B can cover doctor and emergency room visits, clinical research, ambulance services, durable medical equipment, mental health care, and limited outpatient prescription drugs.
Original Medicare does not cover long term care, routine care for dental, vision, and hearing, chiropractic care, acupuncture, cosmetic procedures, or prescription drugs. You must purchase prescription drug coverage separately as Medicare Part D and can obtain some additional benefits including dental, hearing, and vision coverage through a Medicare Advantage plan that offers those benefits.
Medicaid coverage is roughly equivalent to Medicare, except Medicaid has additional programs for children and also provides prescription drug coverage. It can be more difficult to access coverage under Medicaid, because not all facilities accept Medicaid coverage as full payment for your care.
Dual Eligibility For Medicare And Medicaid
You can be eligible for both Medicare and Medicaid if you meet the criteria for both. Medicare even has special programs to help you save money if you have limited resources.
Dual Eligible Special Needs Plans
Under the umbrella of Medicare Advantage plans are Special Needs Plans (SNPs). These plans cater to the specific needs of groups of Medicare beneficiaries with set circumstances. Along with Institutional SNPs and Chronic Care SNPs are Dual Eligible SNPs. Dual Eligible Special Needs Plans find you networks of healthcare providers who accept Medicaid. They also have prescription drug coverage built in to help add to your savings. To sign up for one of these plans, you must be enrolled in both Medicare Part A and Part B and live within the plan’s service area.
Saving Money With Medicare
If you think you may be eligible for both Medicare and Medicaid, we encourage you to apply. For help finding the resources available to you as a Medicare beneficiary, reach out to the team at Insured for Life. We can help you make the most of your plan options.
